Mestrado em Assistência e Avaliação em Saúde (FF)

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    Avaliação da eficácia do nusinersena (Spinraza®) no tratamento de atrofia muscular espinhal: uma revisão sistemática
    (Universidade Federal de Goiás, 2019-11-01) Borges, Stéfani Sousa; Itria, Alexander;; Itria, Alexander; Reis, Angela Adamski da Silva; D’Alessandro, Walmirton Bezerra; Suzuki, Karina; Tobias, Gabriela Camargo
    Spinal muscular atrophy (SMA) is an autosomal recessive neurodegenerative disease characterized by mutations or deletions of the survival motor neuron 1 (SMN1) gene, which leads to degeneration of motor neurons of the spinal cord. Nusinersen, commercially known as Spinraza®, has been approved and incorporated into the Brazilian health system as the first pharmacological treatment for SMA, however, a number of ethical issues have been raised, indicating the need for further studies to confirm the drug’s efficacy. In view of this, the objectives of this study were to assess the efficacy of nusinersen (Spinraza®) in SMA’s treatment through a systematic review of randomized controlled trials (RCTs) and cohort studies, and to evaluate the methodological quality of the included studies. The identification and selection of the studies were conducted by two reviewers, blinded and independent in following databases: Cochrane Library, Embase, Lilacs (via Virtual Health Library) and Medline (via Pubmed). An additional search in references of the included articles and in the international database Clinical Trials was conducted to capture as many publications as possible. As inclusion criteria, were selected the full published full articles of human studies whose objective(s) was to evaluate the efficacy of nusinersena in SMA’s treatment. For quality assessment and bias identification, included RCTs were assessed according to the CONSORT (Consolidated Standards of Reporting Trials) Recommendation and cohort studies in accordance with STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) Recommendation. The search in the databases returned 427 publications, of which 112 were removed by duplication and 309 excluded because they did not meet any of the inclusion criteria, totalizing six publications included in this review, of which two RCTs and four cohort studies. The total population of the analyzed articles yielded 461 both sexes individuals and diagnosed SMA Types I, II or III. The most used motor function improvement rating scales among the studies were HINE-2 and CHOP INTEND. The efficacy of nusinersen (Spinraza®) was compared between studies taking into account the research design, population included, and outcomes identified based on the progress of motor scale scores. The validity of the outcomes was discussed according to the quality of each publication and the risks of biases identified under the CONSORT and STROBE Recommendations. Financial support from the drug-producing industry was identified as the main bias in some of the studies. Scientific evidence has shown a significant improvement in motor function in patients treated with nusinersena, although the combination of the outcomes discussed in this review are not considered sufficient to confirm an increase in patient survival. It was identified that an improvement in the patterns of conduct and reporting of studies included in the review are important attitudes to be adopted.
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    Impacto da implementação da qualidade na fase pré-analítica em um laboratório clínico prestador de serviço para o Sistema Único de Saúde
    (Universidade Federal de Goiás, 2017-12-07) Pedreira, Samira Mariana Naciff; Costa, Sérgio Henrique Nascente;; Amaral, Rita Goreti;; Amaral, Rita Goreti; Silva, Rita de Cassia Pereira da Costa e; Tavares, Suelene de Brito do Nascimento; Feres, Valéria Christina de Rezende; Silva, Karlla Greick Batista da Costa e
    Objective: To evaluate the impact of the implementation of quality in the preanalytical phase in a clinical laboratory providing services for the Brazilian public healthcare system. Method: This study was carried out in three distinct stages. The first stage, before the intervention, was held between June and November 2015, summing up 7,058 consultations. The second stage or stage of interventions was carried out between December 2015 and May 2016. The interventions were carried out through permanent education actions to the professionals involved and implementation of standard operating procedures and forms (POPs, in Portuguese). After the interventions, the third stage began, evaluating the quality indicators in the first semester (between June and November 2016), in a total of 6,317 visits, and in the second semester after the interventions (between January and June 2017), in a total of 6,698 visits. The variables studied were the indicators of nonconformities of registry, nonconformities of collection, hemolysis and recollection and indicators of productivity of receptionists and phlebotomists. Stata 12® was used for statistical analysis. In order to verify the impact of the implementation of the quality, the Chi-square test was used, with a significance level of 5%, and Fisher's exact test. Results In the first semester after the interventions, a reduction of nonconformities related to the reception before the interventions was observed 9.7% after 7.4% (p <0.01) and to the collection before the intervention 1.0% after 0.4% (p <0.01) and increase in nonconformities related to screening before 0.7% after 1.2% (p = 0.003). However, there was no reduction in emissions at 5.1% (p <0.01), collection at 0.3% (p <0.01), and at 0.6% (p = 0.05) . In the first half of the year after the interventions, a significant increase of productivity of the reception desk before 36.4% after 39.30% (p<0.01) and of phlebotomists one before 21.5% after 34.8% and of the two before 14.2% and after 26.7% (p<0.01). In the second semester after the interventions the booth one maintained the productivity, the booth two increased before 31.2% after 6 months 38.4% and the booth three reduced before 32.4% after 6 months 24.7%. Phlebotomists increased productivity in relation to the period before interventions.. Conclusion: There was a positive impact in the implementation of the internal quality control in the preanalytical phase. After intervention, there was a decrease in nonconformities related to reception and collection and an increase of phlebotomist productivity. The reduction of nonconformities may reflect positively on the quality of the service provided to the patient.
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    Perfil epidemiológico e fatores associados à síndrome respiratória aguda grave em Goiás, no período de 2013-2018
    (Universidade Federal de Goiás, 2020-09-02) Araujo, Kamilla Lelis Rodrigues de; Silva, Lara Lívia Santos da;; Ternes, Yves Mauro Fernando;; Silva, Lara Lívia Santos da; Reis, Angela Adamski da Silva; Siqueira Júnior, João Bosco
    Severe Acute Respiratory Syndrome (SARS) is a condition that, in addition to classic symptoms of influenza, shows signs of worsening with high morbidity and mortality. Thus, is a major concern for public health, being a disease of epidemiological importance, thatmust be notified and investigated. Therefore, the aim of this study was analyze the epidemiological profile and associated factors of SARS reported in the state of Goiás, between 2013 to 2018. This is a retrospective cohort study, with data obtained from the National disease notification system - Influenza Web. Logistic regression analysis was performed to verify the association between death and ICU admission and exposure variables by using the SPSS 25.0 statistical package program. Between 2013 and 2018, 4,832 cases of SARS were reported in Goiás. During the analyzed period, the majority of cases was attributed to Influenza virus (A or B), mainly Influenza A (22.3%), with predominance of pandemic H1N1 Influenza 2009 subtype H1N1pdm09 (17,9%). Among the variablesrelated to ICU admission, longer time to start antiviral treatment in days wasassociated with an increase in hospitalization while the absence of previousinfluenza vaccination, longer time to start antiviral treatment and older age wereassociated with deaths. Thus, this study showed a high frequency of SARS in the state of Goiás between the years 2013 and 2018, with the Influenza A virus(H1N1pdm09) being the main etiological agent. Among the factors related toadmission to the ICU and death, the time of initiation of treatment with antiviral, vaccination status and age of the patientwere observed, which highlights theneed for constant monitoring of the epidemiological situation of this disease, inorder to adopt public health measures for prevention and control.
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    Disposição a pagar por um serviço de dispensação de medicamentos: perspectiva da população do município de Goiânia, Goiás, Brasil
    (Universidade Federal de Goiás, 2019-10-02) Rocha filho, César Ramos; Dewulf, Nathalie de Lourdes Souza;; Dewulf, Nathalie de Lourdes Souza; Vieira, Fabiola Sulpino; Cardoso, Larissa Barbosa; Lopes, Angela Ferreira; Provin, Mercia Pandolfo
    Objective: To evaluate the Willingness to Pay (WTP) for a pharmacists’ dispensing service, as strategy to contribute with the debate and to provide subsidies for the optimization of the service in the planning of public health policies in Brazil. Methods: A cross-sectional survey was conducted among residents of Goiânia, Brazil. We applied the contingent valuation method, with dichotomous choice question. Furthermore, Qui-square test and multiple logistic regression model were used to assess the relationship of the participants’ opinions and characteristics with “real” WTP. Results: A sample of 327 interviewed were statically analyzed. More than half (55.96%) were certainty that they would pay 14 BRL for a dispensing service. Moreover, in a context of gratuity, 92.05% of the participants would seek for the service. Characteristics such as education level, family income, respondents’ perception of pharmacists’ abilities, not having used the service, no history with Drug-Related Problems, perceived health status, and recent use of medicines demonstrated to contribute significantly to the prediction of WTP. Conclusion: It was observed a feasibility of implementation and incorporation of the service from society’ perspective. Additionally, we noted some limitations and biases in the WTP study design, which should be carefully considered as the methodology development progresses.
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    Aplicação de diferentes métodos para detecção de eventos adversos a medicamentos em uma unidade de terapia intensiva brasileira
    (Universidade Federal de Goiás, 2016-12-06) Martins, Renato Rocha; Lopes, Flavio Marques;; Lopes, Flavio Marques; Silva, Ana Elisa Bauer de Camargo; Dewulf, Nathalie de Lourdes Souza; Santos, Sílvia Helena Rabelo dos; Pereira, Edna Regina Silva
    Adverse drug events are damage caused by drugs. Their detection is important to identify risks that affect health system users and to design strategies that improve quality on healthcare. This study aimed to apply different methods of adverse drug event detection in patients admitted to intensive care unit of a public tertiary hospital in the Brazilian Midwest from September 2015 to April 2016. This study was approved by Hospital Alberto Rassi Ethics Committee on Research by report number 1,177,803 and the patients were invited to join voluntarily by signing the Informed Consent Form. In order to achieve the above objectives, this research was conducted in two phases. In the first phase, an analytical, retrospective study compared the use of trigger tool and a non-targeted chart review regarding to adverse drug event detection during hospitalization. Identified events were analyzed by multiprofessional team and classified as their causality, predictability, severity and damage level. In the second phase, this is an analytic, interventional study with purpose of evaluate the impact of medication therapy management on detection of drug-related problems and prevention of adverse drug events. Results found in two phases of this study allowed to recognize that all these tested methods were suitable for the purpose. The search for adverse events performed by trigger tool and a non-targeted chart review allowed identification of similar amounts of events, type of event and related drugs. In both groups the most frequently encountered events were related to metabolic, gastrointestinal, cardiovascular and hematological systems. In this phase, trigger tool application showed to be, among the strategies evaluated, the most convenient. The similar performance to non-targeted chart review supports the use of trigger tool in intensive care units routine, since this method requires less time to retrieve information from medical records. However, the possibility of early identifying a drug-related problem, preventing it from reaching the patient, and the possibility of intervening in non-preventable events, reducing harm, confer an advantage on medication therapy management. The proposed clinical pharmaceutical service allowed the detection of 50 adverse drug events, a low frequency compared to other methodologies. Although, this method was not considered inappropriate for the purpose, since it allowed identification and intervention in 170 other drug-related problems that had potential to cause patient damage. Problems identified at this phase were more often related antibacterials use, caused by improper drug combinations, inadequate dosing, and led to interventions that were accepted by the multiprofessional team, with more than 85% of adherence and total problem solving. These proposed detection methods allowed us to recognize characteristics of adverse drug events occurring in the institution. This information can be used later in order to outline strategies for improvement on healthcare quality. Inserting a clinical pharmacist into the multiprofessional team was a protective factor for critically ill patients, since this professional set up an additional barrier in order to detect and prevent adverse drug events, improving the safety on pharmacotherapy.
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    Avaliação molecular dos polimorfismos genéticos na performance motora de atletas de futebol
    (Universidade Federal de Goiás, 2019-06-28) Menezes, Wandelisa Cançado Flores; Santos, Rodrigo da Silva;; Reis, Angela Adamski da Silva;; Santos, Angela Adamski da Silva; Feres, Valéria Christina de Rezende; Lira, Cláudio André Barbosa de; Lopes, Flávio Marques; Mourão, Aline Andrade
    Several genes have been identified as critical in athletic performance. The angiotensin- converting enzyme (ACE) insertion/deletion (I/D) polymorphism has been related to improvements in performance and exercise duration. However, there are large divergences among the studies with on the influence of ACE I/D polymorphism results for physical performance. Other studies have demonstrated that strenuous exercise generally overloads the endogenous antioxidant system’s capacity, leading to oxidative damage to muscles and other tissues in athletes. Moreover, few studies reported significant associations between Glutathione S-Transferases (GST) deletion polymorphisms and resistance performance in athletes. This first study on the central Brazilian population aimed to characterize the effects of ACE I/D and GST deletion polymorphisms on young soccer players. We investigated 65 soccer players from the Under-20 (18 to 20 years old) soccer teams and 60 non-athletes in a case-control study. All subjects had their physical performance investigated through the Running-based Anaerobic Sprint Test (RAST). Genotyping was performed using real-time Polymerase Chain Reaction. We found that the I/D genotype was significantly more frequent in athletes compared with the non- athletes (p=0.01). Individuals with the ID and DD genotypes had an approximately 3.13- fold and 4.37-fold increase in strength and power-orientated performance, respectively. The DD genotype in athletes presented results considered as excellent to good when compared with non-athletes for RAST test. For the association of the GST deletion polymorphisms and RAST test, there was no influence in the athletic performance. Most importantly, we described the associations between ACE I/D polymorphism and athletic performance. In this study, we found that GST polymorphisms indicated no associations for the risk of oxidative damage to the muscle. Our findings may help to select young players with the most favorable genetic potential to succeed as soccer athletes.
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    Desenvolvimento e validação de uma matriz de competências para cursos de Farmácia
    (Universidade Federal de Goiás, 2018-11-08) Brito, Aline de Sousa; Naghettini, Alessandra Vitorino;; Lopes, Flávio Marques;; Lopes, Flávio Marques; Monteiro, Sally Cristina Moutinho; Garcia, Telma Alves; Dewulf, Nathalie de Lourdes Souza; Menezes, Ida Helena Carvalho Francescantonio
    Introduction: The pharmaceutical study goes through several changes and structuring, in requirement to graduate generalists’ professionals, who are able to act in health care, providing pharmaceutical services, in direct contact with the patient and the community enjoying actively in multi-professional group. So, appears the necessity of professors that are committed to new teaching and evaluation methods, to the university student ́s experience with the labour market reality in an attempt to boost the search of knowledge by this university student in order to happen the development of essential skills to the formation of pharmaceutical professionals. The competence can be defined through the capacity to develop attributes (cognitive and psychomotor) and to coordinate and to mobilize knowledge to decision- making. Because of this, the necessity of building a document, which gathers essential information about principal skills that should be developed by pharmacy student. Goals: It ́s to develop and validate a pattern of competence to pharmacy courses. Methods: The article was approved by the ethics and research committee from Federal University of Goiás. It was performed a study with a quality approach through interviews searching an opinion and experience from professors who work at pharmacy courses in different research line. Professors who work in public universities from several regions of Brazil were asked to answer the interview. The interviews were conducted by means of a structured script and recorded in audio. The number of interviewed professors was based on the saturation of the contacts to join in the research. The audios were transcribed and analyzed by the qualitative analysis software called MaxQDA. Thereafter a mold of competences was composed and sent to be evaluated by professors from pharmacy course by electronic form, using Likert scale of 5 points. This evaluation was realized by Delphi method modified in two rounds. Results: The interviewed group was compounded by 25 professors who work at pharmacy courses in different research line. It allowed the identification of 71 skills shared in 7 thematic- categories: Medicine Production and Pharmaceutical Products, Pharmaceutical Logistic, Pharmaceutical care, Clinical and Toxicological Analyses, Food science and Technology, Communication, Professionalism and Management. After the evaluation and suggestions from the experts, this mold went through some changes in the formulation of the items, framework in the categories and incorporation of new items, staying with 87 skills. On the second round after a new analyses from the experts one item was excluded, ending with 86 competences. Conclusions: It was possible to know the professors professional profiles, verify their knowledge regarding the concept of competences and the thematic axes of the DCNs, also to define seven thematic categories from pharmaceutical formation and its essential competences to pharmaceutical professional in Brazil. The study allowed a composition of a competences mold to the pharmacy course which involves all the formation stages of a pharmaceutical professional. Besides, it showed, between the professors, an agreement of ideas and priority to university students formation.
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    O polimorfismo I/D do gene ECA e nefropatia diabética: evidências baseadas em meta-análises
    (Universidade Federal de Goiás, 2018-06-04) Silveira, Luciana Carvalho; Santos, Rodrigo da Silva;; Reis, Angela Adamski da Silva;; Reis, Angela Adamski da Silva; Santos, Rodrigo da Silva; Ternes, Yves Mauro Fernandes; Alcântara, Erikson Custódio
    Diabetic Nephropathy (DN) is a microvascular renal complication of Diabetes Mellitus (DM), characterized by increased albuminuria and progressive loss of renal function. A cumulative incidence of ND in the last 10 years was observed in 40%, mainly in patients with type 2 diabetes mellitus (T2DM), being an important cause of morbidity and mortality among these individuals. The Insertion / Deletion (I/D) polymorphism in the ACE gene could influence the predisposition to DN by vascular modulation in the kidney, through a direct effect on the cellular hypertrophy, influencing the proliferation and the rupture of the extracellular matrix. Many studies about this subject are discordant, a fact that increases the need for joint analysis so that safe conclusions can be generated. The aim of this study was to investigate the association between ACE gene I/D polymorphism and the development of DN in patients with T2DM. Through a standardized research protocol, the bibliographic search was performed in the PubMed and Cochrane Library electronic databases of 1995-2017, selecting case-control observational studies using the terms "polymorphism" AND " ACE gene" AND “diabetic nephropathy ". We included 33 studies in qualitative synthesis and 30 studies for meta- analysis, with 9.077 participants with T2DM genotyped, 4.774 (52, 6%) individuals with DN and 4.303 (47. 4%) individuals without DN. Evaluated separately, the genotypes for the case group, we have I/I (23, 5%), I/D (46, 4%) and D/D (30, 6%). The genotypes for the control group, I/I (28, 6%), I/D (46.19%) and D/D (25%). The highest prevalence observed was of the I/D genotype in both groups. In the allele frequencies calculated by the Hardy-Weinberg Test, the mutant D allele presents with 54% in the case group and 48% in the control group. The wild-type I allele was present in 46% in the case group and 52% in the control group. The present meta-analysis concludes the I/D polymorphism of the ACE gene studied through the I/D and D/D genotypes is not associated with the risk of developing DN in individuals with T2DM, but the presence of the D allele has significant significance in the risk of developing the disease, as well as the protective role of the I allele.
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    Custos decorrentes de eventos adversos a medicamento em pacientes hospitalizados
    (Universidade Federal de Goiás, 2018-04-05) Nascimento, Lais Cardoso do; Itria, Alexander;; Itria, Alexander; Lemos, Lucimeire Fermino; Cardoso, Larissa Barbosa
    Theoretical Background: The adverse drug event (ADE) may occur due to adverse reaction and medication error. Damage caused by adverse events (AD) can lead to increased hospitalization time, rehospitalization, greater morbidity, the need for diagnostic and therapeutic interventions, irreversible consequences such as death and great economic impact. Objective: This study aims to analyze the costs of adverse drug events in hospitalized patients. Methods: This is a retrospective study carried out in a public hospital in the state of Goiás, Brazil, with patients admitted to the adult hospitalization clinics in the year 2016 and who suffered ADE. The colection of data occurred between May and October 2017. The data were collected through a nursing record and patient records. Additional hospitalization time, hours worked by the health professional, therapeutic and diagnostic procedures, and resources used by these users related to ADE were analyzed. In case of death, the average annual salary was calculated by the years of lost work lives for the society. The costs of the materials were obtained through a bidding system and the cost accounting unit of the hospital itself, the Federal Government Price Panel, and procedures through the SIGTAP Table. The data was typed in the Excel worksheet and analyzed by simple statistics. The present study was submitted and approved in the ethics committee with protocol in GEP / HC / UFG nº 030/2017 and was followed what is recommended by Resolution 466/2012. Results: We identified 164 cases of medication errors and adverse reactions in the nursing records. However, only the cases of patients in which the medical record was reported and that additional intervention were included in the study, which totaled 80 cases, 25 of which could have been avoided. The total costs due to EAM identified in the study were R $ 96,877.90. There were direct costs totaling R $ 26,463.90, of which R $ 20,430.36 was obtained from the hospital's perspective and R $ 6,033.54 from the SUS perspective. And of this amount R $ 14,380.13 was due to non-preventable EAM and R $ 12,083.77 due to preventable EAM. In the perspective of society, there were indirect costs of R $ 70,414.00, due to the death due to medication failure. Conclusion: It is concluded that the financial impact requires attention of managers, in the sense that avoiding such costs, it opens up possibilities for new investments.
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    Determinação de fármacos fenólicos em produtos farmacêuticos utilizando um biossensor de polifenoloxidase, obtida de extrato bruto do fruto da jurubeba (Solanum paniculatum L.)
    (Universidade Federal de Goiás, 2018-03-05) Antunes, Rafael Souza; Gil, Eric de Souza;; Lopes, Flávio Marques;; Lopes, Flávio Marques; Santiago, Mariângela Fontes; Alves, Virgínia Farias
    The use of plant enzymes for analytical purposes is increasing every day, especially in the field of biotechnology linked to the development of new and more specific analytical instruments. In this way, the development of biosensors has been increasing since these allow the measurement of the analyte of interest to be performed by the selective transduction of a parameter of the target-analyte reaction that can be monitored. For this reason, the biological element that makes up the instrument, becomes an essential component for its construction. Polyphenoloxidase is an enzyme that catalyzes the conversion of a phenolic compound to a quinone, which can be reduced electrochemically and thus allows the detection (quantification) of the analyte of interest. This enzyme is widely distributed in plants and is widely used in the production of biosensors and the selective evaluation of phenolic drugs in pharmaceutical formulations and total phenols in industrial effluents. The polyphenoloxidases in this specific work were extracted from the fruit of Jurubeba (Solanum paniculatum L.) and used in the development of carbon paste electrochemical biosensors in the determination of phenolic drugs, such as paracetamol, ascorbic acid, salicylic acid and or methyldopa. Under experimental conditions the effect of the amount of enzymatic extract in the carbon paste ranging from 50 to 200 μL and the optimum pH of 3.0 to 9.0 using the differential pulse voltammetry technique was investigated. After optimization, the intermediate precision of the biosensor was tested through its reproducibility through the tests of repeatability, time of conditioning, stability and linearity. Soon after, used in the determination of the drugs, obtaining a better response in the detection of paracetamol, in this way, the calibration curve was realized and consequently applied in the determination of paracetamol of commercial samples in tablets. The biosensor had a linearity in the range of 5 to 245 μM, with a detection limit of 3 μM. The polyphenoloxidase extracted from the fruit of Jurubeba showed peculiar characteristics that it provided in the technological development of biosensors with application in the quality control of phenolic drugs, exhibiting high sensitivity, satisfactory selectivity, good repeatability and adequate stability.
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    Perfil farmacoterapêutico de adolescentes usuários de um centro de atenção psicossocial álcool e drogas infanto juvenil do estado de Goiás
    (Universidade Federal de Goiás, 2017-05-30) Araújo, Sandra Hernandez Morais de; Lopes, Flavio Marques;; Dewulf, Nathalie de Lourdes Souza;; Dewulf, Nathalie de Lourdes Souza; Garrote, Clévia Ferreira Duarte; Cunha, Luiz Carlos; Ferreira, Tatyana Xavier Almeida Matteuci; Santos, Thalyta Renata Araújo
    Introduction: The use of Psychoactive Substances (PS) brings problems in several areas of the subject's life such as: health, psychological and social. Epidemiological studies show that it is in the passage from childhood to adolescence that the use begins. In Brazil, the treatment is preferentially done in the Centers of Psychosocial Care and in them are offered psychosocial and pharmacological interventions and the combination of them. Pharmacological interventions can be used to stabilize, detoxify, ameliorate withdrawal symptoms and prevent relapse. The pharmacist plays an important role in the safe and effective use of medicines in children and adolescents, since it can prevent identifying, evaluating and intervening in problems related to pharmacotherapy. Objective: to analyze the use of drugs by users of the Psychosocial Care Center Alcohol and Drugs Infanto Juvenil 24 hours (CPCAD adi III). Methodology: an analytical and quantitative cross-sectional study, carried out by reviewing medical records. The medical records of users who were younger than 18 years of age and with prescription of medicines were included and the medical records that were not filled out were excluded. Potential drug interactions (PDI) were analyzed using the Micromedex® and Medscape® database. Descriptive and bi-and multivariate logistic regression analyzes were performed considering a statistically significant relationship p≤0.5. Results: Of the 159 records used in the study, 71.7% were male subjects with mean age of 16 ± 1.9 years, incomplete elementary schooling (88%) and the search for treatment occurred in 55, 3% by judicial measure. Among the diagnostic hypotheses, the most frequent were mental and behavioral disorders due to the use of multiple drugs and the use of other psychoactive substances (F19) 34.9% and mental and behavioral disorders associated with the use of cannabinoids (F12) With 17.2%. The age of first use of SP was on average 12.4 ± 1.90 years. The most used PS was Cannabis (37.2%). The most prescribed drugs were the N03A (antiepileptic) 39.94% and N05A (antipsychotic) 34.83%% groups. A total of 815 PDI were found per type of interaction, 352 drugcannabis, 139 drug-ethanol, 125 drug-foods, 99 drug-tobacco, 83 drug-drug, and 17 drug-cocaine. Regarding the severity of the PDI found, 59.4% were moderate, 23.8% were secondary, 15.7% were serious and 1.1% were contraindicated. The drugs that presented the most PDI were chlorpromazine (32.3%) and diazepam (19.6%). Conclusion: the adolescents were the majority of males, the diagnostic hypothesis that had the highest frequency was that of mental and behavioral disorder due to the use of SPA (F-19). The use of PS was on average at 12 years of age and the most consumed PS was marijuana. The most commonly prescribed drugs were valproic acid (30.63%) and chlorpromazine (20.72%). It was found of 815 PDI with 59.4% classified as moderate. The factor involved in polypharmacy was total PDI and among the factors involved in the occurrence of total PDI were: being studying and the amount of diagnostic hypothesis. In view of the high PDI index, the relationship with polypharmacy and a high number of diagnostic hypotheses, it is necessary to increase the attention of health professionals regarding the topic and the development of protocols to support decision making.
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    Aplicação de um algoritmo para avaliação do desempenho de testes diagnósticos para dengue durante epidemia no Centro-Oeste, Brasil (2012-2013)
    (Universidade Federal de Goiás, 2017-04-20) Botelho, Pedro Henrique Dias; Féres, Valéria Christina de Rezende;; Bara, Maria Teresa Freitas;; Bara, Maria Teresa Freitas; Alcântara, Keila Correia de; Argolo, Angela Ferreira Lopes de Teive e; Rocha, Benigno Alberto Moraes da
    Introduction. Laboratory tests are essential for dengue diagnosis, in that sense algorithms are proposed, which proposes instructions for a more effective laboratory dengue diagnosis. Aim. To evaluate the performance of laboratory tests in the confirmation of suspected dengue cases, appling an algorithm, during a dengue epidemic in Goiânia, Central West Brazil 2012-2013. Methodology. This is a retrospective analytical observational study in a database of a prospective cohort with suspected dengue cases. The algorithm applied was based on three periods in the acute phase of disease, 0-3, 4-7 and >7 days after onset of symptoms (DOS) and in detection of immunoglobulins M and G (IgM and IgG), non-structural 1 protein antigen (NS1Ag) and viral RNA by reverse transcriptase-polymerase chain reaction (RT-PCR). Positivity was seen individually and in association of tests in the algorithm and per day of infection, and used to confirm cases. The tests performance was evaluated by the sensitivity, specificity and accuracy of each test when compared to the others association, also in the algorithm. The results were statistically analyzed using SPSS Statistics 17.0, R software and OPENEPI. Results. 592 patients with suspected dengue were included, 415 (70.1%) were laboratory confirmed. In the 0-3 DOS period, the best positivities were by RT-PCR (81.6%) and NS1Ag (63.3%). While, IgM obtained the best positivities in 4-7 and >7 DOS periods (85.5% and 93.3%, respectively). Individually, RT-PCR and IgM tests were the most efficient to add positivity to diagnosis at the beginning and at the end of the acute phase of infection, respectively. Sensitivity results were similar to those of positivity, whereas NS1Ag specificities were greater than 90% at all periods. Conclusion. The algorithm sowed which laboratorial test was the best for the course of disease. Until 3 DOS, molecular is most sensitive test; between 4-7 DOS, two techniques may be required to obtain an accurate diagnostic. NS1Ag test, presented less detection in secondary infection cases, however, they was more specific test and can be used in differential diagnosis of dengue. These results contributed to diagnostic decision in the epidemiological context with concomitant arbovirus circulation.
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    Farmácias magistrais de Goiânia. Análise de não conformidades e penalidades aplicadas
    (Universidade Federal de Goiás, 2017-03-16) Oliveira, Adriana Delcy de; Dewulf, Nathalie de Lourdes Souza;; Diniz, Danielle Guimarães Almeida;; Diniz, Danielle Guimarães Almeida; Garrote, Clévia Ferreira Duarte; Silva, Ana Elisa Bauer de Camargo; Ferreira, Tatyana Xavier Almeida Matteucci; Zampieri, Ana Lúcia Teixeira de Carvalho
    The growing need for medicines as well as the growth of pharmaceutical activity drive the quest for quality. Various process control actions and finished products are constantly reviewed. The actions of health surveillance are associated to the process of regulation, monitoring and inspection of products and services, in order to prevent and reduce risks to individual and collective health in the area of surveillance. The objective of this study was to characterize and quantify the penalties of fine, seizure, interdiction and warnings in magical pharmacies in Goiânia. The methodology used was quantitative, retrospective and analytical, with an evaluation of the relationship between the number of pharmacists, self inspection number, pharmaceutical owner and affiliation, and the number of penalties issued. The Kruskall Wallis and Chi square tests were applied. Data were obtained from the database of the Sanitary Surveillance of Goiânia and sanitary inspections that were carried out in accordance with the Resolution of the Collegiate Board of Directors (RDC) 67/07, which deals with good practices of manipulation of magisterial preparations and For human use in pharmacies. The independent variables (number of pharmacists, number of self-inspections, affiliation or not with a class institution, ownership of a pharmacist and dependents (number of fines, seizures, prohibitions and warnings planned in the survey) were reported. Of pharmacists favors the quality of work performed, that pharmacies that performed self-inspection had a low incidence of occurrence of non-conformities (suffered a lower number of fines), pharmacies affiliated to class institutions suffered a smaller number of prohibitions and that the fact The owner being a pharmacist influenced a smaller number of penalties. The study pointed out that the lower the number of assessments, seizures and prohibitions separately, the lower the total number of penalties.
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    Percepção do farmacêutico sobre a dispensação na atenção primária à saúde
    (Universidade Federal de Goiás, 2016-09-20) Sousa , Juliana Teotônio Mota; Pereira , Edna Regina Silva;; Dewulf , Nathalie de Lourdes Souza;; Dewulf , Nathalie de Lourdes Silva; Rocha , Bárbara Souza; Lopes , Flávio Marques
    Introduction. Medicine dispensing is an exclusive act of pharmacist where it is the delivery and do guidance about medicine using. This process can identify and resolve problems related to pharmacotherapy and to promote the rational drug use. Although medicine dispensing is part of pharmaceutical services policy, it is still rarely performed, especially considering the primary health care (PHC). In order to carry out medicine dispensing according to public policies and current legislation, the pharmacist has to demonstrate competencies in patient-centered care. Aim. The aim of this study was to evaluate pharmacists’ perception of medicine dispensing practice in the primary health care. Methods. This was a qualitative study, in which a semistructured interview was administered to explore pharmacists’ opinion and experiences on dispensing in PHC. The interviews were conducted following a script of questions and audio-recorded. The number of interviews was based on thematic saturation criteria. The data collected was transcribed and analyzed using the thematic content analysis. The study was approved by the Ethics Committee of the Federal University of Goias. Results. Seven pharmacists were interviewed, and the following thematic categories were identified: drug management; drug dispensing; pharmaceutical education. Medicine management and dispensing were mentioned as the main pharmaceutical services performed. However, these are hampered by poor facility conditions, lack of medicine, and problems related to service users, multidisciplinary team, manager and pharmacist assistant who was most of the times responsible for dispensing medicine. In addition, the interviewees pointed out that pharmaceutical education received during the undergraduate course was scarce, mentioning two disciplines in this regard: pharmacology and internship. Most pharmacists referred in the interview that the undergraduate course made only a small contribution to professional practice, resulting in limited knowledge and lack of confidence by the professionals, who admit that medicine delivery, instead of medicine dispensing, is currently performed. On the other hand, most of the interviewees recognized the necessity of a continuing education, such as a master’s degree course. Conclusions. In light of this, in their daily practice, the pharmacists have a distant relationship with the patients, and are dedicated to the management of medicines, whereas pharmacist assistants are in charge of medication dispensing. This professional believes that the Pharmaceutical Education in graduation was deficient. However, feel the need and are interested in Continuing Education. Therefore, investments in continuing education in medicine dispensing is required, to encourage pharmacists to perform it safely and committed to patients’ health.